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2025 HCPCS code S0201

Partial hospitalization services, less than 24 hours, per diem.

This code is not payable by Medicare but may be covered by other payers. Always verify coverage with individual payers.

Medical necessity for partial hospitalization services is established when a patient requires intensive, structured treatment for a mental health or substance use disorder that cannot be effectively provided in a less intensive outpatient setting. Documentation must support the intensity of service required.

This code is used by providers of partial hospitalization services, such as hospitals and community mental health centers. Clinical responsibility includes coordinating the multidisciplinary team involved in the patient's care, which may include psychiatrists, psychologists, nurses, social workers, and therapists. The team develops and implements a treatment plan, monitors the patient's progress, and provides ongoing assessment and support.

IMPORTANT:H0035 (Mental health, partial hospitalization, treatment, less than 24 hours) is an alternative code that may be used by some payers.

In simple words: This code is used for billing when someone receives intensive mental health treatment during the day at a hospital or clinic, but goes home at night.

This code covers partial hospitalization for patients with mood disorders, mental illness, personality disorders, or substance abuse, provided on a per diem basis. The service requires less than 24 hours of care per day. The patient resides at home and visits the hospital or community mental health center for intensive, structured treatment during the day. Services may include those provided by a psychiatrist, psychologist, psychiatric nurses, social workers, and rehabilitation therapists.

Example 1: A patient with major depressive disorder is admitted to a partial hospitalization program for intensive therapy, medication management, and support. They attend the program for six hours per day, five days a week, and return home each evening., An individual with a substance use disorder participates in a partial hospitalization program that offers group therapy, individual counseling, and relapse prevention skills training. The program runs for four hours per day, three days a week., A patient with an acute exacerbation of bipolar disorder transitions from inpatient hospitalization to a partial hospitalization program to stabilize their mood and adjust medications while maintaining a structured environment during the day.

Documentation should include the diagnosis, treatment plan, daily progress notes, and discharge summary. It should also reflect the medical necessity for the partial hospitalization services.

** While some sources indicate S0201 is not payable by Medicare, coverage and reimbursement may vary between private payers. Always verify with specific payers regarding coverage policies and coding guidelines. S0201 is sometimes used by non-Medicare payers for substance use disorder partial hospitalization.

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